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Nobrega GM, Jones BR, Mysorekar IU, Costa ML. Preeclampsia in the Context of COVID-19: Mechanisms, Pathophysiology, and Clinical Outcomes. Am J Reprod Immunol 2024; 92:e13915. [PMID: 39132825 PMCID: PMC11384281 DOI: 10.1111/aji.13915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/14/2024] [Accepted: 07/29/2024] [Indexed: 08/13/2024] Open
Abstract
The emergence of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to the global COVID-19 pandemic, significantly impacting the health of pregnant women. Obstetric populations, already vulnerable, face increased morbidity and mortality related to COVID-19, aggravated by preexisting comorbidities. Recent studies have shed light on the potential correlation between COVID-19 and preeclampsia (PE), a leading cause of maternal and perinatal morbidity worldwide, emphasizing the significance of exploring the relationship between these two conditions. Here, we review the pathophysiological similarities that PE shares with COVID-19, with a particular focus on severe COVID-19 cases and in PE-like syndrome cases related with SARS-CoV-2 infection. We highlight cellular and molecular mechanistic inter-connectivity between these two conditions, for example, regulation of renin-angiotensin system, tight junction and barrier integrity, and the complement system. Finally, we discuss how COVID-19 pandemic dynamics, including the emergence of variants and vaccination efforts, has shaped the clinical scenario and influenced the severity and management of both COVID-19 and PE. Continued research on the mechanisms of SARS-CoV-2 infection during pregnancy and the potential risk of developing PE from previous infections is warranted to delineate the complexities of COVID-19 and PE interactions and to improve clinical management of both conditions.
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Affiliation(s)
- Guilherme M Nobrega
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Brittany R Jones
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Indira U Mysorekar
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
- Huffington Center on Aging, Baylor College of Medicine, Houston, Texas, USA
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
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Nobrega GDM, Granja F, Pietro L, Ribeiro-do-Valle CC, Amorim MR, Forato J, Metelus S, Silveira C, Souza RT, Cecatti JG, Proenca-Modena JL, Costa ML. SARS-CoV-2 genome detection and viral viability in breast milk samples of unvaccinated postpartum women. Int J Gynaecol Obstet 2024. [PMID: 39056511 DOI: 10.1002/ijgo.15831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/15/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024]
Abstract
SynopsisThis assessment of SARS‐CoV‐2 in breast milk is reassuring for the maintenance of breastfeeding even in cases of infected pregnant women unvaccinated for COVID‐19.
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Affiliation(s)
- Guilherme de Moraes Nobrega
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Fabiana Granja
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Biodiversity Research Centre, Federal University of Roraima, Boa Vista, Roraima, Brazil
| | - Luciana Pietro
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Institute of Health Sciences, Universidade Paulista, Campinas, São Paulo, Brazil
| | | | - Mariene Ribeiro Amorim
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Julia Forato
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Sherly Metelus
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Carla Silveira
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Renato Teixeira Souza
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - José Guilherme Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - José Luiz Proenca-Modena
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Experimental Medicine Research Cluster (EMRC), University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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The COVID-19 pandemic in Brazilian pregnant and postpartum women: results from the REBRACO prospective cohort study. Sci Rep 2022; 12:11758. [PMID: 35817818 PMCID: PMC9272878 DOI: 10.1038/s41598-022-15647-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/27/2022] [Indexed: 11/11/2022] Open
Abstract
Brazil presented a very high number of maternal deaths and evident delays in healthcare. We aimed at evaluating the characteristics of SARS-CoV-2 infection and associated outcomes in the obstetric population. We conducted a prospective cohort study in 15 Brazilian centers including symptomatic pregnant or postpartum women with suspected COVID-19 from Feb/2020 to Feb/2021. Women were followed from suspected infection until the end of pregnancy. We analyzed maternal characteristics and pregnancy outcomes associated with confirmed COVID-19 infection and SARS, determining unadjusted risk ratios. In total, 729 symptomatic women with suspected COVID-19 were initially included. Among those investigated for COVID-19, 51.3% (n = 289) were confirmed COVID-19 and 48% (n = 270) were negative. Initially (before May 15th), only 52.9% of the suspected cases were tested and it was the period with the highest proportion of ICU admission and maternal deaths. Non-white ethnicity (RR 1.78 [1.04–3.04]), primary schooling or less (RR 2.16 [1.21–3.87]), being overweight (RR 4.34 [1.04–19.01]) or obese (RR 6.55 [1.57–27.37]), having public prenatal care (RR 2.16 [1.01–4.68]), planned pregnancies (RR 2.09 [1.15–3.78]), onset of infection in postpartum period (RR 6.00 [1.37–26.26]), chronic hypertension (RR 2.15 [1.37–4.10]), pre-existing diabetes (RR 3.20 [1.37–7.46]), asthma (RR 2.22 [1.14–4.34]), and anaemia (RR 3.15 [1.14–8.71]) were associated with higher risk for SARS. The availability of tests and maternal outcomes varied throughout the pandemic period of the study; the beginning was the most challenging period, with worse outcomes. Socially vulnerable, postpartum and previously ill women were more likely to present SARS related to COVID-19.
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Guida JP, Cecatti JG, Souza RT, Pacagnella RC, Ribeiro-do-Valle CC, Luz AG, Lajos GJ, Surita FG, Nobrega GM, Griggio TB, Charles CM, Miele MJ, Ferreira SB, Tedesco RP, Fernandes KG, Martins-Costa SH, Ramos JG, Peret FJ, Feitosa FE, Traina E, Cunha Filho EV, Vettorazzi J, Haddad SM, Andreucci CB, Correa Junior MD, Mayrink J, Dias MA, Oliveira LG, Melo Junior EF, da Luz MG, Costa ML. Preeclampsia among women with COVID-19 during pregnancy and its impact on maternal and perinatal outcomes: results from a national multicenter study on COVID in brazil, the REBRACO initiative. Pregnancy Hypertens 2022; 28:168-173. [PMID: 35568019 PMCID: PMC9085347 DOI: 10.1016/j.preghy.2022.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 04/09/2022] [Accepted: 05/05/2022] [Indexed: 12/31/2022]
Abstract
Objective To evaluate the prevalence of preeclampsia among cases of COVID-19 infection during pregnancy and the association between both conditions, in a multicenter cohort of Brazilian women with respiratory symptoms. Study design Ancillary analysis of the Brazilian Network of COVID-19 in Obstetrics (REBRACO) study. We performed a nested case-control analysis selecting all women with COVID-19 and compared outcomes between women with and without PE. Main outcomes Maternal, gestational, and clinical characteristics and perinatal outcomes. Measures Prevalence ratio (PR) and its 95%CI for each of the predictors and outcomes. Results A total of 203 women were included: 21 (10.3%) in PE group and 182 (89.7%) in non-PE group. Preeclampsia was not different among women with and without COVID-19 (10.3% vs 13.1%, p-value = 0.41), neither complication such as eclampsia and HELLP syndrome. Chronic hypertension (33.4%) (p < 0.01) and obesity (60.0%) (p = 0.03) were the most frequent comorbidities in PE group, and they were significantly more frequent in this group. Women with PE had more cesarean section (RR 5.54 [1.33 – 23.14]) and their neonates were more frequently admitted to neonatal intensive care unit (PR 2.46[1.06 – 5.69]), most likely due to preterm-birth-related complications. Conclusion The prevalence of PE among women with COVID-19 infection during pregnancy was around 10%; women with COVID-19 and a history of chronic hypertension or obesity are more likely to have preeclampsia. Cesarean section is increased among women with PE and COVID-19, with increased rates of neonatal admission to intensive care units, mostly due to prematurity.
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Costa ML, Souza RT, Pacagnella RC, Bento SF, Ribeiro-do-Valle CC, Luz AG, Lajos GJ, Mazon SB, Bahamondes L, Surita FG, Nobrega GM, Griggio TB, Charles CM, Miele MJ, Tedesco RP, Fernandes KG, Martins-Costa S, Peret FJ, Feitosa FE, Mattar R, Traina E, Cunha Filho EV, Vettorazzi J, Haddad SM, Andreucci CB, Guida JP, Correa Junior MD, Dias MAB, Oliveira LG, Melo Junior EF, Menezes CA, Luz MG, Cecatti JG. Brazilian network of COVID-19 during pregnancy (REBRACO: a multicentre study protocol). BMJ Open 2021; 11:e051284. [PMID: 34921076 PMCID: PMC8685531 DOI: 10.1136/bmjopen-2021-051284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the clinical, epidemiological and laboratory aspects of SARS-CoV-2 infection during pregnancy and postpartum in 16 maternity hospitals. METHODS AND ANALYSIS A prospective multicentre study, with five axes. First, the prevalence of SARS-CoV-2 infection among women admitted for childbirth will be described in a cross-sectional study. Second, maternal and perinatal outcomes will be assessed in a prospective cohort study including pregnant or postpartum women with suspected COVID-19. Third, a cohort of positive COVID-19 cases with sampling of a variety of biological material. Histopathological and viral analysis of biological maternal and neonatal samples will be performed, and the assessment of nutritional variables to evaluate the association between vitamin D and severity of infection. Fourth, a monitoring and evaluation committee to collect relevant healthcare information and plan actions in centres facing the pandemic. Furthermore, qualitative studies will be performed to study pregnant women, their families and health professionals. Fifth, an ecological study will monitor the number of live births, stillbirths and other outcomes to explore any trend among the periods before, during and after the pandemic. Data will systematically be collected in an electronic platform following standardised operational procedures. For quantitative study components, an appropriate statistical approach will be used for each analysis. For qualitative data, in-depth interviews recorded in audio will be transcribed, checking the text obtained with the recording. Subsequently, thematic analysis with the aid of the NVivo programme will be performed. ETHICS AND DISSEMINATION Ethical approval was obtained (letters of approval numbers 4.047.168, 4.179.679 and 4.083.988). All women will be fully informed to sign the consent form before enrolment in the study. Findings will be disseminated through peer-reviewed journals and scientific conferences.
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Affiliation(s)
- Maria Laura Costa
- School of Medical Sciences. Department of Obstetrics and Gynaecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynaecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynaecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Silvana F Bento
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Carolina C Ribeiro-do-Valle
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Adriana G Luz
- Obstetrics and Gineacology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Giuliane J Lajos
- Obstetrics and Gineacology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Silvia B Mazon
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Fernanda G Surita
- Obstetrics and Gyneacology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Guilherme M Nobrega
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Thayna B Griggio
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Charles M'poca Charles
- Department of Obstetrics and Gynaecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Maria J Miele
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | - Ricardo P Tedesco
- Department of Obstetrics and Gynecology, Faculdade de Medicina de Jundiai, Jundiai, Brazil
| | - Karayna G Fernandes
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
- Department of Obstetrics and Gynecology, Faculdade de Medicina de Jundiai, Jundiai, Brazil
| | - Sergio Martins-Costa
- Department of Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Frederico Ja Peret
- Department of Obstetrics and Gynecology, Unimed Belo Horizonte, Belo Horizonte, Brazil
| | - Francisco E Feitosa
- Department of Obstetrics and Gynecology, Sociedade de Assistencia a Maternidade Escola Assis Chateaubriand, Fortaleza, Brazil
| | - Rosiane Mattar
- Department of Obstetrics and Gynecology, UNIFESP, Sao Paulo, Brazil
| | - Evelyn Traina
- Department of Obstetrics and Gynecology, UNIFESP, Sao Paulo, Brazil
| | - Edson V Cunha Filho
- Department of Obstetrics and Gynecology, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Janete Vettorazzi
- Department of Obstetrics and Gynecology, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Samira M Haddad
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
| | | | - José Paulo Guida
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, Brazil
| | | | | | - Leandro G Oliveira
- Department of Obstetrics and Gynecology, UNESP Campus de Botucatu, Botucatu, Brazil
| | | | - Carlos As Menezes
- Obstetrics and Gyneacology, Salvador University, Salvador, BA, Brazil
| | | | - Jose Guilherme Cecatti
- Department of Obstetrics and Gynecology, State University of Campinas Faculty of Medical Sciences, Campinas, Brazil
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Costa ML, Souza RT, Pacagnella RC, Bento SF, Ribeiro-do-Valle CC, Luz AG, Lajos GJ, Nobrega GM, Griggio TB, Charles CM, Tedesco RP, Fernandes KG, Martins-Costa SHA, Peret FJA, Feitosa FE, Mattar R, Cunha Filho EV, Vetorazzi J, Haddad SM, Andreucci CB, Guida JP, Correa Junior MD, Dias MAB, Oliveira LG, Melo Junior EF, Menezes CAS, Luz MGQ, Cecatti JG. Facing the COVID-19 pandemic inside maternities in Brazil: A mixed-method study within the REBRACO initiative. PLoS One 2021; 16:e0254977. [PMID: 34297740 PMCID: PMC8301675 DOI: 10.1371/journal.pone.0254977] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 07/07/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION COVID-19 pandemic posed major challenges in obstetric health care services. Preparedness, development, and implementation of new protocols were part of the needed response. This study aims to describe the strategies implemented and the perspectives of health managers on the challenges to face the pandemic in 16 different maternity hospitals that comprise a multicenter study in Brazil, called REBRACO (Brazilian network of COVID-19 during pregnancy). METHODS Mixed-method study, with quantitative and qualitative approaches. Quantitative data on the infrastructure of the units, maternal and perinatal health indicators, modifications on staff and human resources, from January to July/2020. Also, information on total number of cases, and availability for COVID-19 testing. A qualitative study by purposeful and saturation sampling was undertaken with healthcare managers, to understand perspectives on local challenges in facing the pandemic. RESULTS Most maternities early implemented their contingency plan. REBRACO centers reported 338 confirmed COVID-19 cases among pregnant and post-partum women up to July 2020. There were 29 maternal deaths and 15 (51.8%) attributed to COVID-19. All maternities performed relocation of beds designated to labor ward, most (75%) acquired mechanical ventilators, only the minority (25%) installed new negative air pressure rooms. Considering human resources, around 40% hired extra health professionals and increased weekly workload and the majority (68.7%) also suspended annual leaves. Only one center implemented universal screening for childbirth and 6 (37.5%) implemented COVID-19 testing for all suspected cases, while around 60% of the centers only tested moderate/severe cases with hospital admission. Qualitative results showed that main challenges experienced were related to the fear of the virus, concerns about reliability of evidence and lack of resources, with a clear need for mental health support among health professionals. CONCLUSION Study findings suggest that maternities of the REBRACO initiative underwent major changes in facing the pandemic, with limitations on testing, difficulties in infrastructure and human resources. Leadership, continuous training, implementation of evidence-based protocols and collaborative initiatives are key to transpose the fear of the virus and ascertain adequate healthcare inside maternities, especially in low and middle-income settings. Policy makers need to address the specificities in considering reproductive health and childbirth during the COVID-19 pandemic and prioritize research and timely testing availability.
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Affiliation(s)
- Maria Laura Costa
- Department of Obstetrics and Gynecology, University of Campinas, Campinas/SP, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynecology, University of Campinas, Campinas/SP, Brazil
| | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, University of Campinas, Campinas/SP, Brazil
| | - Silvana F Bento
- Department of Obstetrics and Gynecology, University of Campinas, Campinas/SP, Brazil
| | | | - Adriana G Luz
- Department of Obstetrics and Gynecology, University of Campinas, Campinas/SP, Brazil
| | - Giuliane J Lajos
- Department of Obstetrics and Gynecology, University of Campinas, Campinas/SP, Brazil
| | - Guilherme M Nobrega
- Department of Obstetrics and Gynecology, University of Campinas, Campinas/SP, Brazil
| | - Thayna B Griggio
- Department of Obstetrics and Gynecology, University of Campinas, Campinas/SP, Brazil
| | - Charles M Charles
- Department of Obstetrics and Gynecology, University of Campinas, Campinas/SP, Brazil
| | | | | | | | | | | | - Rosiane Mattar
- Universidade Federal de São Paulo UNIFESP/EPM, São Paulo/SP, Brazil
| | | | - Janete Vetorazzi
- Hospital das Clínicas de Porto Alegre, Porto Alegre/RS, Brazil
- Hospital Moinhos de Vento-HMV, Porto Alegre/R, Brazil
| | - Samira M Haddad
- Hospital Regional Jorge Rossmann Instituto Sócrates Guanaes, Itanhaém/SP, Brazil
| | | | | | | | - Marcos A B Dias
- Instituto Fernandes Figueira IFF/Fiocruz, Rio de Janeiro/RJ, Brazil
| | - Leandro G Oliveira
- Faculdade de Medicina da Universidade Estadual de São Paulo, Botucatu/SP, Brazil
| | | | | | | | - Jose G Cecatti
- Department of Obstetrics and Gynecology, University of Campinas, Campinas/SP, Brazil
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Nobrega GDM, Guida JPS, Japecanga RR, Antolini-Tavares A, Mysorekar I, Costa ML. Placental Sampling for Understanding Viral Infections - A Simplified Protocol for the COVID-19 Pandemic. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:377-383. [PMID: 34182582 PMCID: PMC10305292 DOI: 10.1055/s-0041-1729146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) is a pandemic viral disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The impact of the disease among the obstetric population remains unclear, and the study of the placenta can provide valuable information. Adequate sampling of the placental tissue can help characterize the pathways of viral infections. METHODS A protocol of placental sampling is proposed, aiming at guaranteeing representativity of the placenta and describing the adequate conservation of samples and their integrity for future analysis. The protocol is presented in its complete and simplified versions, allowing its implementation in different complexity settings. RESULTS Sampling with the minimum possible interval from childbirth is the key for adequate sampling and storage. This protocol has already been implemented during the Zika virus outbreak. CONCLUSION A protocol for adequate sampling and storage of placental tissue is fundamental for adequate evaluation of viral infections on the placenta. During the COVID-19 pandemic, implementation of this protocol may help to elucidate critical aspects of the SARS-CoV-2 infection.
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Affiliation(s)
| | | | | | | | - Indira Mysorekar
- Washington University School of Medicine, St. Louis, MO, United States of America
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Surita FGDC, Luz AG, Hsu LDPR, Carvalho FHC, Brock MF, Nakamura MU. Outpatient care for pregnant and puerperal women during the COVID-19 pandemic. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:588-592. [PMID: 32992361 PMCID: PMC10309212 DOI: 10.1055/s-0040-1718473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
| | - Adriana Gomes Luz
- Departamento de Tocoginecologia, Faculdade de Ciêcias Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Adanu RMK, Goggins A. IJGO: Continuing to advance women's health research and practice globally. Int J Gynaecol Obstet 2020; 151:1-2. [PMID: 32781489 DOI: 10.1002/ijgo.13315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Amy Goggins
- FIGO (International Federation of Gynecology & Obstetrics), London, UK
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